集束化干预理念在食管癌肠内营养支持中的应用  

Application of intervention bundles in enteral nutrition for patients with esophageal cancer

作　　者：徐达夫[1] 田文泽[1] 嵇建[1] 胡忠吾[1] 尤振兵[1] 郭伟[1] 孙永建[1] Xu Dafu Tian Wenze Ji Jian Hu Zhongwu You Zhenbing Guo Wei Sun Yongjian(Department of Thoracic Surgery, Huai＇an No. 1 Hospital, Nanjing Medical University, Huai＇an, Jiangsu 223300, China)

机构地区：[1]南京医科大学附属淮安第一医院胸外科,江苏淮安223300

出　　处：《中华临床营养杂志》2017年第3期171-175,共5页Chinese Journal of Clinical Nutrition

摘　　要：目的 探讨集束化干预理念在食管癌围手术期肠内营养支持中的价值.方法 收集2014年10月至2015年9月在本院行食管癌根治术的食管鳞癌患者226例,其中2015年4至9月共109例（研究组）围手术期运用集束化干预理念加强肠内营养支持;2014年10月至2015年3月共117例（对照组）围手术期按常规处理.结果 两组患者实验室指标的营养状况对比显示术前两组白蛋白、前白蛋白、转铁蛋白相比,差异均无统计学意义（P均＆gt;0.05）,术后第8天比较,白蛋白[（38.2±3.5）g/L比（36.3±4.8）g/L,P=0.001]、前白蛋白[（126.7±52.8）g/L比（72.9±42.3）g/L,P=0.001]、转铁蛋白[（2.9±1.2）g/L比（2.1±1.6）g/L,P=0.001],研究组均显著高于对照组;研究组和对照组并发症的发生率分别为11.01％（12/109）和21.37％（25/117）,两组比较差异有统计学意义（X2=4.422,P=0.035）;研究组术后排气时间[（52.8±10.9）h比（58.7±14.3）h,P=0.001]、拔除胸腔引流管时间[（3.5±0.9）d比（4.8±1.3）d,P=0.001]、术后住院时间[（11.2±1.3）d比（12.1±1.5）d,P=0.001]、住院总费用[（3.7±0.4）万元比（3.9±0.5）万元,P=0.004]均显著低于对照组.结论 集束化干预理念在食管癌围手术期营养支持中的应用具有较大临床价值,可以明显改善患者的营养状况、降低并发症的发生率和改善患者临床结局.Objective To investigate the value of intervention bundles in enteral nutrition for patients with esophageal cancer.Methods From October 2014 to September 2015,226 patients with esophageal squamous cell carcinoma were collected.From April 2015 to September 2015,109 patients（intervention group）were treated with intervention bundles during perioperative period,and from October 2014 to March 2015,117 patients（control group）were treated by routine intervention.Results The albumin,prealbumin,and transferrin showed no significant difference（all P〉0.05）before treatment but were significantly different on the eighth day[albumin：（38.2±3.5）g/L vs.（36.3±4.8）g/L,P=0.001;prealbumin：（126.7±52.8）g/L vs.（72.9±42.3）g/L,P=0.001;transferrin：（2.9±1.2）g/L vs.（2.1±1.6）g/L,P=0.001].The incidence of complications was 11.01%（12/109）in intervention group and 21.37%（25/117）in control group（X2=4.422,P=0.035）.In addition,the postoperative exhaust time[（52.8±10.9）h vs.（58.7±14.3）h,P=0.001],time to the removal of chest drainage tube[（3.5±0.9）d vs.（4.8±1.3）d,P=0.001],postoperative hospital stay[（11.2±1.3）d vs.（12.1±1.5）d,P=0.001],and hospital costs[（37±4）thousand yuan vs.（39±5）thousand yuan,P=0.004] were also significantly shorter or smaller in the intervention group.Conclusions Intervention bundles is clinically valuable in the early enteral nutrition for patients with esophageal cancer.It can improve the nutritional status of patients,reduce complications,and improve the clinical outcomes.

关 键 词：食管肿瘤 肠道营养 集束化干预 

分 类 号：R459.3[医药卫生—治疗学] R735.1[医药卫生—临床医学]